Is early or late tracheostomy more effective in critically ill COVID-19 patients who are expected to require long-term artificial ventilation? Key messages • For adults hospitalized with COVID-19 on mechanical ventilators, performing an early tracheostomy (where doctors cut through the skin into the trachea (windpipe) to insert a breathing tube) before 10 days after starting ventilation, may have little or no effect on deaths and the time patients spend on a ventilator compared with late tracheostomy, performed 10 days or more after starting ventilation. • We are uncertain whether early...

How accurate is artificial intelligence for diagnosing keratoconus? Key messages • The included studies suggest that artificial intelligence (AI) can identify keratoconus. This may lead to early detection and prevention of vision loss. • Estimates were similar for different types of AI algorithms. • We have little confidence in the evidence; there is a need for more research on this topic. What is keratoconus and why is (early) diagnosis so important? Keratoconus is a disease of the cornea (the clear window at the front of the eye) that affects people between the ages of 10 and 40 years. In...

Cognitive behavioural interventions for reducing fear of falling in older people living in the community Key messages – Cognitive behavioural therapy (CBT) with and without exercise probably reduces fear of falling in older people living in the community, when measured once treatment has ended. Improvements may be sustained during the first six months after treatment finished, and probably last beyond six months. – As a consequence of these interventions, people may be less likely to avoid activities after treatment and their level of depression may be reduced. – It is unclear if the...

Ventilation tubes (grommets) for otitis media with effusion (OME or 'glue ear') in children Key messages - From the studies included in this review, we are uncertain to what extent ventilation tubes improve hearing. Glue ear is a fluctuating condition, with high rates of spontaneous resolution and recurrence, which makes it difficult to study in a clinical trial. - Ventilation tubes may slightly reduce the number of children who have glue ear after three to six months of follow-up. It is not clear whether they also have an effect over longer periods of time. - Insertion of...

Interventions to prevent or cease electronic cigarette use in children and adolescents Key messages There are currently no published randomised controlled trials assessing the impact of interventions to prevent or stop e-cigarette use amongst children and adolescents. We did, however, find 22 of these types of studies underway that appear to be eligible for future updates to this review, which may provide more answers. What did we want to find out? We wanted to find out how effective interventions were in either preventing or ceasing (i.e. stopping) child and/or adolescent e-cigarette use....

Pulmonary rehabilitation using minimal equipment for people with chronic obstructive pulmonary disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of pulmonary rehabilitation with minimal equipment on key clinical outcomes in people with chronic obstructive pulmonary disease, compared to usual care, no training, or equipment-based training. This is a protocol....

Factors for predicting treatment success and severe adverse events of chimeric antigen receptor (CAR) T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To identify and meta-analyse prognostic factors for efficacy and safety of CAR T-cell therapy for treating aggressive large B-cell lymphomas before therapy has started. Population Adult patients with a confirmed diagnosis of a relapsed or refractory aggressive large B-cell lymphoma (DLBCL, PMBCL, FL grade 3b, HGBCL) who received CAR...

What are the benefits and risks of health literacy interventions for migrants? Health literacy (HL) means the knowledge, motivation and competencies (e.g. reading and writing abilities) that people need to find, understand, evaluate and use health information. Migrants are at risk for difficulties in HL (e.g. when they don't know the country's health system well). 'Generic' HL means that people can find, understand and use general health information to make health decisions. 'Disease-specific' HL means that people can find, understand and use information about a certain disease or that they...

Comparison of two treatment options for kidney stones What are kidney stones? Kidney stones are collections of calcium-containing material that are usually hard and can form in one or both kidneys. Kidney stones can form when high levels of certain minerals form crystals in the urinary tract. These stones can be as small as a grain of sand or as large as a pea. In rare cases they can be as big as golf balls. Small kidney stones may not cause symptoms or severe pain. Larger stones can block urine from leaving the kidney. How are kidney stones treated? People with large kidney stones often...

Community-based exercise and physical activity for chronic low back pain This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of community-based exercise programmes compared to no additional treatment or healthcare professional-delivered treatment for chronic low back pain. This is a protocol....

What are the benefits and harms of medicines that increase blood flow to the extremities (phosphodiesterase 5 inhibitors (PDE5i)) compared to placebo for the treatment of Raynaud's phenomenon? Key messages PDE5i may reduce slightly the frequency and duration of attacks of Raynaud's phenomenon, and may improve the patient's overall assessment of their disease, but may make little to no difference in pain compared to people taking a fake pill (placebo). It is unclear if PDE5i has an effect on the severity of an attack. Compared to people treated with placebo, people treated with PDE5i are...

Temperature and storage conditions for human insulin What is insulin? Insulin is a hormone made by the pancreas that helps your body turn food into energy and controls your blood sugar levels. People with diabetes cannot make enough insulin or use it effectively, so some have to inject it themselves. How should insulin be stored? Health authorities and pharmaceutical manufacturers recommend keeping insulin away from sunlight, not freezing it and storing it in a refrigerator. Unopened human insulin vials or flasks and cartridges for insulin pens should be stored at temperatures between 2 °C...

Higher-protein formula versus lower-protein formula: which works better to prevent malnutrition and obesity in infants? Key messages 1. We are unsure if high-protein formula affects malnutrition or obesity in infants. 2. Larger studies are needed to further evaluate the benefits and potential harms of the different types of formula. 3. Future research should focus on long-term growth and brain development. What are high- and low-protein infant formulas? Infant formulas have a similar nutritional content to breast milk, and contain ingredients such as cow's milk, fats, vitamins, proteins...

Antibiotic treatment to reduce the duration and severity of travellers’ diarrhoea This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of antibiotic treatment for travellers’ diarrhoea in relation to: illness duration; adverse effects; acquisition of multidrug-resistant organisms. This is a protocol....

Head impulse, nystagmus, and test of skew (HINTS) examination for causes in the brain of acute dizziness Key Messages The HINTS and HINTS Plus examinations were reasonably accurate for diagnosing a central cause for acute vestibular syndrome (AVS). What is acute vestibular syndrome? Acute vestibular syndrome is a specific type of dizziness, which can include severe vertigo (spinning sensation), nausea and vomiting, nystagmus (involuntary eye movements), or unsteadiness. Acute vestibular syndrome can be due to peripheral causes (those within the ear canal) or central causes (those within the...

Vaginal energy-based devices for vulvovaginal dryness This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of vaginal energy-based devices for women with vulvovaginal dryness related to genitourinary syndrome of menopause (GSM) or hormone therapy. This is a protocol....

What are the benefits and risks of methylxanthines (mild stimulant medicines) for premature babies whose breathing pauses during sleep (apnea)? Key messages - Compared to no treatment or a placebo (inactive) medicine, methylxanthines probably lead to fewer apnea episodes (pauses in breathing), probably reduce the need for breathing machines, and do reduce lung injury in preterm babies. - Methylxanthines probably make little or no difference to the risk of preterm babies dying before leaving hospital. There was little evidence about side effects of methylxanthines. - More research is needed...

What are the benefits and risks of using tests for lung maturation to assess if preterm newborns need to receive surfactant therapy to improve lung function? Key messages • Respiratory distress syndrome is a common condition in preterm infants, while the benefits of surfactant therapy guided by tests for lung maturation remain unclear. • No studies reported neonatal death (first 28 days of life) or neurodevelopmental outcome. It is uncertain whether surfactant therapy guided by tests for lung maturation has an effect on death prior to hospital discharge. Surfactant treatment guided by rapid...

What are the benefits and risks of tranexamic acid for percutaneous nephrolithotomy for the treatment of kidney stones? Key messages • Tranexamic acid, when compared to placebo (or no medication), may reduce blood transfusions, surgical complications, and a patient's hospital stay following percutaneous nephrolithotomy. • Tranexamic acid, when compared to placebo (or no medication), may improve the removal of stone material following percutaneous nephrolithotomy but may increase unwanted medication effects. • We do not know if tranexamic acid affects the risk of blood clots forming in other...

Endometrial injury in women attempting to conceive following sexual intercourse or intrauterine insemination: a collaborative individual participant data meta-analysis (IPD-MA) This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of endometrial injury for reproductive outcomes in women following sexual intercourse or intrauterine insemination compared to placebo or no intervention. This is a protocol....